Ohio Department of Job and Family Services …

1 JFS 07038 (Rev. 11/2004) Page 1 of 2 Ohio Department of Job and Family Services acknowledgment OF paternity AFFIDAVIT Ohio Revised Code Section (Please read the important information on this page before completing the affidavit on the reverse side) Notice of Rights and Responsibilities and Due Process Safeguards Completion of the acknowledgment of paternity affidavit is voluntary. If a man voluntarily acknowledges a parent and child relationship by signing an acknowledgment of paternity affidavit (hereafter paternity affidavit), he assumes the parental duty of support which may be enforced through a child support order. Both parents who sign this paternity affidavit waive any right to bring a court action to establish paternity pursuant to sections to of the Revised Code or make a request for an administrative determination of a parent and child relationship pursuant to section of the Revised Code, other than a court action filed for purposes of rescinding the paternity affidavit.

2 There are some circumstances set forth in state law under which either parent may rescind the paternity affidavit after it is signed (pursuant to sections , , and of the Revised Code). To rescind the paternity affidavit, no later than 60 days after the date of the latest signature on the acknowledgment of paternity affidavit, either parent who signed it must do both of the following: 1. Request an administrative determination of a parent and child relationship from the county child support enforcement agency in which the child, guardian or legal custodian of the child resides and 2. Send a written notice to the Central paternity Registry to the address below that you have requested an administrative determination of a parent and child relationship, and include in the notice the name of the child support enforcement agency conducting the genetic tests.

3 After the 60 day period and within one year after the paternity affidavit becomes final pursuant to sections , or of the Revised Code, either parent who signed the paternity affidavit or the alleged father may file an action with the court to rescind the paternity affidavit on the basis of fraud, duress, or material mistake of fact. A man who is determined to be the father of a child has the right to petition a court for an order granting him reasonable parenting time with respect to the child (pursuant to section of the Revised Code) and petition the court for custody of the child (pursuant to section of the Revised Code). Pursuant to section , an unmarried female who gives birth to a child is the sole residential parent and legal custodian of the child until a court issues an order designating another person as the residential parent and legal custodian.

4 The court will treat the mother and father on an equal standing when making this designation. If a child, a man, a child=s mother, or a person who represents them is not sure if the man is the child=s father, paternity may be established through genetic testing. Testing can be arranged, usually without charge, through the child support enforcement agency (CSEA) if a court or an administrative action to establish paternity is filed. If testing is desired, do not sign the paternity affidavit but instead contact the local CSEA and request genetic tests. If the test shows that a man is the father, the agency will then issue an administrative order establishing paternity and may proceed to determine a child support order. Purpose of this Affidavit The purpose of the paternity affidavit on the other side of this form is to acknowledge the legal existence of a father and child relationship through voluntary paternity establishment.

5 This paternity affidavit cannot be signed if another man is legally presumed to be the father of the child. Pursuant to Ohio Revised Code section , a man is presumed to be the legal father of a child in the following circumstances: 1. A man is married to the child=s mother at the time of the child=s birth; or 2. A child is born within 300 days after a man and the child=s mother separate after signing a separation agreement, the marriage is ended by court order, or the marriage is ended by death of the man or the mother; or 3. A man has already signed an acknowledgment of paternity Affidavit which has been filed with the Ohio Department of Job & Family Services and the acknowledgment has not become final. A legal father and child relationship can also be established through a court or administrative order. Instructions * Type or print legibly in dark blue or black ink.

6 * All spaces in the child=s, mother=s, and father=s sections must be filled out. Do not erase, cross out, white out, or write over information. If an error is made, the parents must start over on a blank affidavit. * Both the natural father and mother of the child are required to sign this affidavit. The affidavit may be signed without being in each other s presence. However, each parent=s signature must be notarized at the time of signing by either the same notary public or different ones. * After the affidavit has been completed, signed, and notarized, it must be sent within 10 calendar days of the last signature to the following address: Central paternity Registry 131 North High Street, Suite 320 Columbus, Ohio 43215 * You can contact the Central paternity Registry if you have any questions at (614) 224-8909 or toll free at 1-888-810-6446.

7 JFS 07038 (Rev. 11/2004) Page 2 of 2 PLEASE READ THE IMPORTANT INFORMATION ON THE REVERSE SIDE BEFORE COMPLETING THIS PAGE *Please type or print in dark blue or black ink* CHILD S INFORMATION Name:_____ Sex: Male Female (First) (Middle) (Last) Date of Birth: _____ Place of Birth: _____ (Mo/Day/Year) (City) (County) (State) Current Residence: _____ (Full Street Address) (City) (County) (State) (Zip) If a birth certificate for the child has already been filed, do you now wish to change the child s name?

8 YES NO If YES , give the child s new name: _____ (First) (Middle) (Last) MOTHER S AFFIRMATION (Name at the time of child s birth) Name: _____ Maiden Name: _____ (First) (Middle) (Last) Address: _____ Phone # : (____)_____ (Full Street Address) (City) (County) (State) (Zip) (Area Code) (Number) Date of Birth: _____ State or Country of Birth: _____ Social Security Number: _____ (Mo/Day/Year) SIGNATURE AND NOTARIZATION State of _____, County of _____, ss.

9 I state under oath or by affirmation that I have read or had read to me all information on both sides of this form; that the information I have supplied for this form is true to the best of my knowledge and belief; that I have received information regarding my legal rights and responsibilities; and that I am the natural mother of the child named on this form and I assume the parental duty of support of the child. _____ Signature of the Mother (Please read page one (1) before signing your name) Before me appeared the above named person (mother) who signed this affidavit under oath or by affirmation on this _____ day of _____, in the year _____. _____ _____ Signature of Notary Public Expiration of Commission FATHER S AFFIRMATION Name: _____ Race/Ethnic Origin: _____ (First) (Middle) (Last) Address: _____ Phone #:(____)_____ (Full Street Address) (City) (County) (State) (Zip) (Area Code) (Number) Date of Birth: _____ State or Country of Birth: _____ Social Security Number: _____ (Mo/Day/Year) Occupation: _____ Employer: _____ Education.

10 (specify highest level 0-12/College 1-4, 5+) _____ SIGNATURE AND NOTARIZATION State of _____, County of _____, ss. I state under oath or by affirmation that I have read or had read to me all information on both sides of this form; that the information I have supplied for this form is true to the best of my knowledge and belief; that I have received information regarding my legal rights and responsibilities; that I consent to the jurisdiction of the courts of this state; and that I am the natural father of the child named on this form and I assume the parental duty of support of the child. _____ Signature of the Father (Please read page one (1) before signing your name) Before me appeared the above named person (father) who signed this affidavit under oath or by affirmation on this _____ day of _____, in the year _____.